Closing the Pediatric AD Referral Gap: What Specialists Need to See

Lisa Swanson, MD, addresses the practical barriers pediatricians face when trying to refer a patient with AD. Chief among them is the national shortage of pediatric dermatologists — just over 400 practice in the United States, and seven states have none at all. Given that gap, she encourages pediatricians to also consider general dermatology clinicians comfortable treating children, as well as allergists who routinely see pediatric patients. She frames this as building a local "phone a friend" network within one's own community, rather than waiting for an ideal referral option that may not exist nearby. She underscores the urgency of these referrals by describing how poorly controlled eczema disrupts an entire household: a constantly itching child doesn't sleep, which means parents and often siblings don't sleep either, compounding the toll on the whole family.

Swanson then details what she looks for in an incoming referral to make that first specialist visit as productive as possible. She wants to know the AD's severity, even a simple mild, moderate, or severe designation, and whether the patient has a history of secondary infection such as staph, MRSA, or eczema herpeticum — any of which raises the urgency of the referral in her eyes. Most valuable of all, she says, is documentation that the patient has already trialed a topical corticosteroid and a topical calcineurin inhibitor. Because insurance step-therapy requirements typically require proof of that trial-and-failure before approving more advanced treatments, having it already on record lets her move straight to therapies more likely to help — getting the patient better faster.

In the next episode, "Misdiagnosis Pitfalls and the Hidden Consequences of Uncontrolled AD," Swanson circles back to diagnosis, walking through a commonly missed AD presentation and the surprising range of health consequences that follow when the condition goes uncontrolled.